Provider Demographics
NPI:1396374146
Name:FORZA PHYSICAL THERAPY PLLC
Entity Type:Organization
Organization Name:FORZA PHYSICAL THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:DERRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:NORTHRUP
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:208-221-6952
Mailing Address - Street 1:605 TAYLOR LN
Mailing Address - Street 2:
Mailing Address - City:CHUBBUCK
Mailing Address - State:ID
Mailing Address - Zip Code:83202-5169
Mailing Address - Country:US
Mailing Address - Phone:208-221-6952
Mailing Address - Fax:844-946-0909
Practice Address - Street 1:605 TAYLOR LN
Practice Address - Street 2:
Practice Address - City:CHUBBUCK
Practice Address - State:ID
Practice Address - Zip Code:83202-5169
Practice Address - Country:US
Practice Address - Phone:208-221-6952
Practice Address - Fax:844-946-0909
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-03
Last Update Date:2020-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty